When the United States entered World War I on April 6, 1917, the Army Medical Department operated only four general hospitals and was in many ways unprepared for the scale and nature of the conflict ahead. This article examines the war's impact on Letterman General Hospital in San Francisco, which was the largest of the four hospitals before the war. In addition to tripling in capacity, Letterman incorporated many of the Medical Department's new services, the most significant concerning orthopedics and physical rehabilitation. The army's embrace of the ethic of rehabilitation was part of a major change in how the government managed care and compensation for those wounded in war—a change that marked a shift, continuing to this day, in how both state and society understand the relationship between disability and citizenship. After the war, Letterman incorporated new requirements for treating veterans in support of the country's evolving veterans’ health care system, which at times was unable to provide the full level of care the government had pledged and that many veterans had come to expect.

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